Becoming a Credentialed Provider
Being reimbursed for providing Medical Nutrition Therapy by third party payors is both possible and beneficial for Georgia RDs, but there is a process one must go through to make this happen.
Step one- Become licensed in Georgia.
Step two- Obtain an NPI number (National Provider Identifier)
Step three- Become a Medicare- visit the CMS website to enroll
Step four- Fill out your CAQH Form. CAQH Universal Provider Datasource. First you must request that an insurance company allow you to become a provider. Humana and BCBS of Georgia are two good ones to start with. They will issue you a number that will allow you to complete all the appropriate documentation with CAQH. To complete this documentation you need to have several pieces of information including
1. Insurance declaration with 1 million/5 million coverage.
2. State license
3. Passport size photo
Step Five- Once you have received confirmation from CAQH, you can apply to become a provider for other insurance companies and Medicaid
Step Six- During this process, you will need to sign a contract for reimbursement. In many situations, you can negotiate your fees. You should base your fees on your business expenses (rent, overhead, marketing…) as well as what you need to make as a salary.
Begin seeing clients and billing for your services. If you are in private practice, you can receive reimbursement directly. If you are working for a physician practice, a hospital, or other type of clinic, you can reassign reimbursement to the business/facility. A physician referral is required for reimbursement of MNT. The MNT codes approved by Medicare are and recognized by other payors are 97802, 97803, 97804, G0270 and G0271. For more information on this process, visit the coding and coverage section of the Academy of Nutrition and Dietetics website, www.eatright.org
Aetna- Currently credentials RDs only through a discount program. The RD agrees to give Aetna members a discount for their services.
Credentialing Provider Relations Liason
770-346-2062 / F 860-975-1525
American Specialty Health
Blue Cross Blue Shield of Georgia- does credential RDs as providers
Contract Manager Ancillary Services
Margaret Mahone- Rep for GA
404-842-8461 / Fax 404-842-8099
3350 Peachtree Rd NE
Mail Code G00501
Atlanta, GA 30326
Cigna- Does not currently credential RDs, although some RDs who were credentialed through Great West (which was purchased by Cigna around 2009-2010) are able to bill for services with Cigna
Medicaid- Begin by going to www. gdhp.georgia.gov to begin credentialing to become a Medicaid provider. Once credentialed with the state, one will approach each of the CMOs. There are three Care Management Organizations who provide coverage for Georgia Medicaid- Amerigroup, Peachstate, and Wellcare. One needs to become credentialed with all three CMO’s. The process can take several weeks.
United Healthcare- RDs are not currently credentialed with UHC unless accidentally or through a physician practice. Typically UHC uses a discount program where their members receive a discount from using UHC member RDs (Optum program)
Network Account Manager
3720 Davinci Court Suite 300
Norcross, GA 30092
United Voice Portal at 877-842-3210.